Provider Demographics
NPI:1780794164
Name:NGUYEN, HOAI NAM THI (PA-C)
Entity type:Individual
Prefix:
First Name:HOAI NAM
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 W SUNSET BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3704
Mailing Address - Country:US
Mailing Address - Phone:424-238-5084
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 305
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3704
Practice Address - Country:US
Practice Address - Phone:424-238-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101679363A00000X
CAPA52768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291131100Medicaid
FLP66323Medicare UPIN
FL291131100Medicaid